Dumfries Business Expo Registration
Name
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First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
Business Name
*
Business Address
*
Street Address
Street Address Line 2
City
State / Province
Postal / Zip Code
Existing or Proposed Business
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Existing
Proposed
Business Type (Please define if other)
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Commercial/Retail
Industrial
Other
Is your business located within the Town of Dumfries
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Yes
No
If your business is located within the town limits of the Town of Dumfries and you have a valid Town business license, you are eligible for the Mayor's Roundtable. Would you like to attend?
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Yes
No
Do you have retail space available for rent or lease within the Town?
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Yes
No
NAICS Code (If known)
General Release of Liability and Assumption of Risk: I agree to indemnify, defend and hold harmless, the county and their officers, agents, and employees from any claims, dangers, and actions of any kind or nature, whether at law or in equity, arising from my participation in the program for which I am registering myself and/or my dependents, provided that such liability is not attributable to the sole negligence of the Town. I realize that my participation in this activity involves risk of injury, including but not limited to tendonitis, strains, bursitis, fractures, delayed muscle soreness, contusions, abrasions, serious eye damage, and eve the possibility of death. Also, I recognize that there are many other risks of injury including serious and disabling injuries, which may arise due to my participation in this activity, and that it is not possible to specifically list each and every individual injury risk. By signing this form I desire, consent, and voluntarily choose to take part in all such activities. Knowing the material risks and appreciating, knowing, and reasonable anticipating that other injuries and each is a possibility, I assume all the risks, normally incident to the nature of the activities and agree that the Town or any of its officers, agents, and employee's conduction such activities will not be responsible for any damages or injuries resulting to me. Furthermore, I acknowledge that I have been given a physician’s permission to participate in physical activity or that I have decided to participate in physical activity without the approval of a physician. Also, I understand that any injury incurred and the resulting medical expense from that injury will be my responsibility, and the Town will not be responsible for any related expenses.
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I accept
Submit
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